Participation in a relaxation response based mind-body group intervention was associated with improvements in disease-specific measures, trait anxiety and pain catastrophizing in patients with irritable bowel syndrome and inflammatory bowel disease, according to study findings.

The quality of life in patients with IBS and IBD is often significantly affected and influenced by stress and resiliency associated with these conditions.

Braden Kuo, MD, of the gastrointestinal unit at Massachusetts General Hospital, and colleagues sought to assess the impact of a 9-week relaxation-response based mind-body group intervention in patients with IBS (n = 19) and IBD (n = 29). The intervention focused on relaxation-response and the building of cognitive skills. They assessed symptom questionnaires and inflammatory markers before and after the intervention, and again at short-term follow-up.

Braden Kuo

Results indicated significant improvements in Pain Catastrophizing Scale scores post-intervention for IBD and at short-term follow-up for both IBS and IBD (from 10.7 at baseline to 5.0 at week-13, P = .02 for IBS; and from 14.8 to 9.6, P < .01 for IBD).

In addition, significant improvements were observed in Trait Anxiety scores from baseline to week-10 (from 39.0 to 33.7, P = .02 for IBS; and from 39.3 to 33.6, P < .01 for IBD). IBS-QOL scores increased from a mean of 67.1 at baseline to 74.8 at week-10 (P = .01) and to 80.6 at week-13 (P < .001); IBS Symptom Severity Index scores significantly decreased from a mean of 215 at baseline to 154 at week-5 (P < .01), 128 at week-10 (P < .001) and 147 at week-13 (P = .01); and IBD Questionnaire scores increased from a mean of 171 at baseline to 185 at week-10 (P < .01) and sustained at 184 at week-13 (P = .02).

Compared with 1,059 genes altered with the intervention among those with IBD, 119 genes were altered in those with IBS. Reduced expression of intervention response genes was significantly associated with inflammatory response, cell growth, proliferation and oxidative stress-related pathways in those with IBD. Significant upregulation of cell cycle regulation and DNA damage related gene sets were observed after the intervention in those with IBS.

Top focus molecules identified in IBS were TNF, AKT and NF-&#954;B; whereas inflammation (VEGF-C, NF-&#954;B) and cell cycle and proliferation (UBC, APP) associated genes emerged as top focus molecules in IBD, according to the researchers.

“Observed gene expression changes suggest that NF-&#954;B is a target focus molecule in both IBS and IBD — and that its regulation may contribute to counteracting the harmful effects of stress in both diseases. Larger, controlled studies are needed to confirm this preliminary finding,” Kuo and colleagues wrote.

Disclosure: The study was supported by a grant from the CDC and the International Foundation for Functional Gastrointestinal Diseases. The researchers report being a consultant for, receiving funding from and serving on the boards of Basis, Civitas Therapeutics, Furiex, Genova Diagnostics, Given Imaging, Lantheus Medical Imaging, Onyx Pharmaceuticals and Shire Human Genetic Therapies.

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